SweetSouthernLove

Hello AmandaPanda101, First and foremost, congrats on your new job! ? I am unsure if you are a new graduate nurse or a nurse who has switched into the NICU specialty. After orienting many a nurse in multiple nursing specialties I can give you what I know to be true. Now to business, entering into such a specific specialty of NICU is very challenging. There is a vast array of knowledge and experience you do not know. Also, while 4 months is a decent amount of time for an orientation, you will not truly have your bearings until about a year, and this goes for nursing in ALL specialties no matter what your experience level. Everything is new...patients, people, coworkers, management, etc. I do sense by your post that maybe the preceptors/management may not be the most supportive/patient people in the room...however, now that you are in the thick of it, you must make the most of every single minute of whatever orientation you have left. As I tell all my nursing preceptees, be happy for this moment, this moment is your life. On orientation, really from day 1, you should see one, do one and then teach one. I am sorry if this has not happened to you. DO as much as humanly possible, DO it AGAIN until you feel comfortable doing it alone. ANYTHING that is offered for you to attempt, do it. Be ANNOYING with asking questions. There is someone who knows the answer, even if it isn't your preceptor that day. My second piece of advice would be to find the most patient and educational preceptor out of the bunch you have had and request them, if possible. I was selected to precept nurses for this personality trait, some nurses will stop in their tracks and love to educate, some see you as an anchor for their entire shift, some see you as compromising their already short staffed overloaded unit with critically ill babies and don't think you should be there in the first place. While it is the 11th hour in your training, be very transparent and speak up about what you need from your unit, even if you think you need an extension on your orientation, who you think can best provide that to you and also put this in writing and give it to your manager. The same way they have a competency packet for you, please give this to them and self-assess and explain to them you may need to extend your orientation by a month or two so you feel absolutely comfortable caring for their patient population, also this CYAs and I tell all nurses to do this because you have worked so hard for your license, protect it. Also if you haven't, please please PLEASE purchase malpractice insurance if you haven't already. My third piece of advice is, whenever you are not in the clinical arena, STUDY, STUDY, STUDY. Study your most common diseases, pathophysiology, medications, your emergency event information, whatever it is that is giving you anxiety and the jitters. A competent nurse, a nurse who KNOWS her specialty will be the best nurse to care for that patient population. The true education starts before, after and any moment that you are not in a clinical setting. I would say this to all nurses if I could but you actually ARE the sum of what you know in this career. Medicine and nursing is everchanging at light speed and honestly you will never know ALL there is to know. But do not give up because your patient's lives however big or small or young or old literally depend on it. All this to say I am not implying you are incompetent, just novice to the specialty and while experience comes with time, knowledge is immediate and something you are in full control of. I also sense from your post you may be worried about your position and your work environment with your coworkers. I am not saying to go and tattle at HR anytime soon but if the work environment is aggressive or hostile in a way where you cannot safely perform your duties or continue to precept in this environment this may unfortunately be the next step in this position. You are there to learn, and with that comes YOUR learning style, not their predated timeline. Ideally, yes, you should be safe enough at this stage to perform basic nursing duties in your unit, however, when critical events arise they should definitely continue to overshadow until you are fit for duty for the best interest of their patients. I would ideally like to see an experienced nurse take a new nurse under his/her wing for a year until they are safe to practice. No ifs, ands or buts. But this is an ideal world, not the one we live in. So please, soak up every bit of training you can, dive in also with any experiences offered, find YOUR people and don't let management/administration or otherwise make you feel like you can't become what you want here because you TOTALLY CAN. Best of luck and I hope this helped.

Second this. In my teaching hospital I have suggested (and been ignored) that there should be a time out for induction and extubation of patients. Without it there is literally no surgical procedure happening. Some RNs, techs, residents, doctors, surgeons I have seen on the moon in personal conversations while their patient is across the room being inducted. The only place I want to be while my patient loses their muscle tone and ability to breathe on their own is next to them while it happens. Wild to me.

Hello All, Currently I have been a non-clinical nurse for the last 6 years in Utilization Review and currently work remotely. I love my job, however, have an itch to go back to the clinical world. (I know..I am insane) My clinical experience includes CVOR and ambulatory surgery and I while I still love the OR and it is my true calling to be in surgery, I would like to explore ER nursing. Since this newfound discovery of mine, I have encountered quite a few road blocks during interviews in my local hospitals. Right now, I have an interview on 5/6 for a Level 1 Trauma ER for a part-time day shift position. I was told I was qualified to interview because I would only need to brush up on fellowship classes rather than undergo the actual year-long fellowship they offer at certain times of the year. This is so far the furthest I have got with trying to enter a new specialty. Is it wise to start out in an ER like this? Is there anything that would be helpful for me to do before I even accept the position? Any thoughts, advice etc. would be extremely helpful. I know there will be a steep learning curve after being nonclinical so long, however I am willing to invest the time and energy to get back up to speed. Thank you!

Hello All, Does anyone work for your or CM for an insurance company and a facility? If so, was there any conflict of interest at either job? Was considering doing this as I currently work for an insurance company and wanted to pick up part-time at a facility to pay off student loans. Thanks!

I come from an OR background, specifically cardiovascular/cardio-thoracic surgery. Outpatient vascular surgery with a salary sounds like a dream to me, but then again, I am a die-hard OR nurse. Outpatient surgery is just that, outpatient. You will have the most stable patients that are coming to surgery. You may also have a variety of surgical procedures that are quick to moderate in length, unlike lengthy vascular procedures that are often inpatient due to extensive comorbidities (TEVAR, bypasses etc.). No call for a specialty like this is practically unheard of. It is the reason I am no longer a CVOR nurse because your “on call-life” is usually very extensive and can cause you to be married to that job. So, in my eyes the pros and cons are: PROS: -SALARIED. Awesome. Period. -No on-call or working late (hopefully), and this will probably ebb and flow because there may be days where you leave early. Similar to a call schedule. Like say Monday you leave an hour early because you are done with surgery for the day and Friday you stay an hour late because products or people or whatever is running behind. This could be looked at as a negative if you are salaried. Again, you will learn your time management (turnover, case length, prepping the OR at the beginning of the day etc. etc). -Outpatient patients (the most stable surgical patient population) -Specialty – no learning multiple surgical specialties. You will hopefully learn your surgeons inside and out (preference cards are golden, make or take notes of these!) within a couple of months of being there. - No weekends, no holidays, no call. You have more of your life back..and if you have a family…or even if you don’t, this will eventually matter to you over time. Take advantage of these perks! CONS: -SURGEONS are like old baseball gloves, they generally don’t like change. They need to trust you to be competent. They are the captain of the OR, so do your best to always be attentive and always learning. They will be grouchy for awhile because you’re new and learning, which is totally normal. But if you learn their preferences and little idiosyncrasies they won’t want any other nurse doing their surgeries but you. -Very specialized – If you love vascular surgeries this can be a pro. But being well rounded inside of the inpatient surgical realm is also helpful, especially with outpatient surgery. -Outpatient surgery is usually fast paced: small, quick cases or moderate 1-2 hours max. This may not be the case with vascular, but this will include quick turnover times and constantly moving, but in a good way. I would say this is probably also a pro, considering what specialty you’re coming from. Personally, I loved outpatient surgery. I loved the pace, you will learn a lot. And changing specialties always gives me nausea and anxiety because it’s simply the unknown. So, I wish you the BEST of luck. Hopefully you’re going to love it!

I would say this is appropriate to do as a new nurse until you grasp your own rhythm and time management. Then come in when it is time to clock in. Think of it as accelerated self-study. All nurses are different but we all have licenses to protect. The more you know about the life that you are responsible for in that half of your day the better everything runs and this is just my experience. I am not sure what unit you are working on or how much autonomy you have from your preceptor right now but taking time solo to look up all the unknowns of the day can put you at a great advantage. Usually there isn't much time between unit huddle, shift report/hand off before you are off to do your initial assessments and grab meds. If someone has a complicated pathological process going on you need to know it. Not through RN report but know the concept of the disease process and what is normal vs. abnormal. This is learning and gaining experience. Some nurses may know how much time they need to wrap their head around things, others may be super quick and are masters at their craft. If you can find the time to do this ON the clock, well by all means DO these things ON the clock. If not, and you find that you clock in and can't "research" adequately then you should find out how much time you do actually need to know things about your patients. This is important not only for you but the entire team caring for that patient on that day. During rounds you should be speaking for your patient as the bedside nurse, at least where I come from this is what occurs. A good thing you can practice with your preceptor is having he/she ask you what is going on with your patients for that day. So you both start off on the same page. Being a relatively new nurse would be the only reason I would agree with this situation. Things will happen during your shift where you may have to know a lot of information in just a short amount of time. Basically, this is a skill, like other nursing skills, and you are new so you can perfect it as you gain more experience.

Because becoming a veterinarian is too long in school and too much debt. Little did I know I would be in grad school with 130k+ in student loans. Should have became the vet.

Hi All, I graduated in December of 2015 from nursing school. Since then I have worked strictly as an operating room/scrub nurse for my entire nursing career. I do still love being an OR nurse but I am wondering if I could even enter a new specialty at this point? I have a special interest in the Cath Lab but I know I would need to be proficient with critical care patients first and I am open to the challenge of learning. Is there tips/courses/orientations etc that would be helpful? I also feel that I would need to relearn my bedside skills so I would be proficient but I wasn't sure if orientations would include this? My main concern is being a safe nurse. I want to be as safe for my patients as possible and take my time learning what is best for them and transition to Cath Lab when I feel ready eventually. I haven't been to a nursing orientation in another specialty so I feel like a fish out of water. Any helpful information would be great!

I have always had two RNs in my CVORs, which I feel benefits both the surgical staff and patients. I was curious if this is a common occurrence all over especially due to nursing shortages. We staff CVOR with 2 RNs, 2 scrubs, 1 PA/ARNP and this is the same way that call is set up as well. 2 RNs come in, 2 scrubs come in. It is the only way I have ever ran a CVOR, but again I have not worked in a facility where there was only 1 RN for this type of room. Now with that being said, I have done open AAA repairs alone with myself and one scrub and two surgeons and it was an on-call situation and CVOR was standby. They eventually wound up calling in a second circulator but that was because my call shift was about to end. I stayed and helped the relief but she would have been alone otherwise. Is there a protocol for this? Is it AORN standard to have 2 circulators? How do nurses feel about this?

I would really scout and probe hiring recruiters, sometimes if you spend enough time talking with them they can adjust your orientation. I just was hired on as a PRN in the OR with the same problem as you and I got out of the week long orientation completely. You could ask for maybe an accelerated orientation? Like a one day campus orientation, EMR, your med access and pharmacy info and a tour of the place you will be actually working so you can get a locker or whatever else you need to set up with other staff. Again, I don't speak for all hospitals or all nurses, this is what I was able to work out with a recruiter. Some hospitals who are open to hiring traveling nurses often have stuff like this available for this reason as well. Hopefully you can get it! My 9-5 is a desk job as well and I wanted to keep my OR nursing skills sharp. Good luck!

Pray!.. No I am kidding! But no seriously..Listen to these lovely nurses and have some fun saving those lives! ?

As a regular staff nurse consistently caring for patients in a clinical setting I always carried personal nursing malpractice insurance. It ranges maybe $150-200/year and to me it is worth it. I was previously insured with Mercer Proliability and now I am insured with Nurses Service Organization (NSO) and they both provide about the same coverage. My patients aren't aware that I hold this coverage so I am not really sure what you mean as in regards of having "something to take." I keep this coverage even now when I do not work in the clinical setting much as I am currently PRN in an OR and work for an insurance company now. The bottom line is, employers may offer malpractice/liability, and if a claim is made against you it will be your employer they are working for, not you. This can be problematic for many reasons. Surprisingly, a large number of nurses do NOT carry this insurance when they should. It pays for a defense attorney and any settlement/judgment against the nurse. People insure their homes, cars, pets etc. but not their careers which is surprisingly odd considering most people live paycheck to paycheck and this coverage is dirt cheap compared to other insurance premiums. Please, do your research and educate yourself to the best of your ability. Sometimes insurance is tricky, but often times the employer has fine print regarding this type of insurance and how it protects you, as a nurse or a provider you have a right to look at this at anytime if you are employed with them and providing patient care. This type of situation also can be problematic for private practices, when providers move from one employer to another or have a gap in work history without what is called "tail coverage." It is best practice and recommended that nurses carry their own liability insurance policy if a claim of malpractice is made specifically against them. As a nurse who has worked both in insurance and in clinical and non-clinical areas of nursing, my recommendation would be to at least look at policies, try to find a reasonable one that fits your needs and never let it lapse, especially if you continue on in education. Best of luck.

First off, bless your heart for even considering to stay. But no, you should not. The fact that your manager tells you that she no longer trusts you and that you probably won't change is a huge red flag for how she is doing her job. The preceptor should be auditing your chart if you feel unsure of yourself, no matter how busy or whatever the preceptor thinks, they still need to do this because both of your licenses are on the line. I would quit this job immediately though and probably not even put in my two weeks because you are probably still in a 90 day probationary period. This is a terrible situation to be in but I wouldn't risk my license on a boss who has it out from me from the start. In the future, and I know you are new so you may not know what is the correct way to chart something, but find someone who does and drag them to your computer to confirm what you have charted is correct. I have had to do this to multiple people multiple times when I was a newb in a new hospital or unit, etc. etc. and they always say "well it's your license." Yes, it is my license and that is why I am trying to be as accurate as I know how to be. Also, under orientation you should be documenting in those charts as such. The primary assigned nurse should be the first person in that chart and you should be an orientee. I apologize for this happening to you but I really wouldn't want to work an environment where my boss didn't have my back and blatantly told me so. You worked hard for your license, if you leave now your boss won't even have to be your recommendation for somewhere else which is important to think about in the long term. Just go in her office and tell her that you tried the job out and you don't think it is any longer a good fit for you. Give your two weeks or whatever you feel is necessary and walk. You will be glad you did.

Personally, I love 5 8's which is what we call it in the OR. The charting is straight forward, the EMAR/orders are straightforward and the best part about your shift is if you have questions your physician/surgical team is right there to clarify. On the other hand, you may have a sleeping patient but you will have your physician/surgical team who will depend on you for just about everything AND you will be the first person in their line of fire/cursing and blame if something isn't just so. There are just different stressors that you may have to get used to. You are orchestrating the entire OR from preop and PACU and even other areas like sterile supply, anesthesia assistance and sales/vendor reps during surgeries. I clock in at 0645 and I am in my car at 1515 LATEST. There is never staying late to chart for 2-4 hours afterwards unless you are doing some kind of outpatient cases, in which case I would say maybe 30 minutes or so just to double check everything and that is me saying that because I know nurses need to do this in order to CYA. Also, working a shift like 7-3 for example, your relief or call team should be there around 2:30-2:45 latest to get report and take over the surgery and this is precisely the purpose of call teams so if the chart or the work isn't complete, then you will report off to the oncoming/on-call surgical staff and at that point is when I would do a once over of my charting, but again, it isn't as tedious as Q2/Q4 head to toe assessments, PIE notes, etc. etc. on the floor. What type of hospital will depend a lot on how often you are utilized for call. Smaller hospitals generally (and I say this very loosely) don't have crazy cases going on in the middle of the night. But there ARE cases that are urgent/emergent and need to be in the OR, so when on call pack breakfast, lunch and dinner because you may have to work right through your shift without getting a chance to go home. For example, I work 7-3 but Billy Bob is here from 7-5 so my call wouldn't start until 5pm when he is to go home for the day because he isn't on call. At that point the OR would call me to come back to work and relieve him if surgery was expected to go past 5 and I would leave when the case was finished. If there is not a "late person" I would start my call right at the time my shift would end which would be 3pm. Also, just because they call once when you are on call doesn't mean they can't call you six times until you aren't on call anymore. I have been called back three times in the same call shift. Generally rule of thumb is expect longer days with big, trauma and teaching hospitals. These hospitals can run late cases, transplants, operate all hours of the day or night and increase your call if their department is short-staffed. I personally despised floor nursing because of what you are going through. I worked consecutive 12s just to get away from the hospital as much as I could. A fellow nurse always used to say this to me and I agree, "I will take my worst day in the OR over my best day on the floor anytime." Call is entirely different and being a floor nurse I am not sure how well versed you are about what it entails. You don't have resources readily available on-call like you do on a regular Monday morning. Consider it like a ghost town when you are on-call and that is how you will have to orchestrate your surgery for those shifts. 3 days and one weekend every two months is minimal call so just know your resources, where things are, how to get a hold of people and what to do in emergencies like MH/RRT/Codes and you should be fine. Weekend call is usually 48 hours starting from 7am Saturday to 7am Monday if you take the entire weekend. Best of luck.

Do it. You will be doing something in two years anyways. Focus on balance and time for yourself as well. Most of us have been right where you are as nursing students, nurses or in some other capacity in health care and that is what makes nurses so great. There is a great quote by Maya Angelou that I have posted in my office and it has been up since I encountered my own struggle so I will pass it on to you, "You may encounter many defeats, but you must not be defeated. In fact, it may be necessary to encounter the defeats, so you can know who you are, what you can rise from, and how you can still come out of it." Nursing is one of the most trusted professions because we don't give up on our patients and as a patient, that is exactly the kind of person you want on your side fighting for your health and your life.